Flu Season is Around the Corner

Resident and Employee Influenza Immunization Consent Forms

 

Learn more from the CDC about people at high risk for influenza:


 


 
Infection Control Resources

 
Use this two-sided form (Side One: Influenza, Side Two: Pneumococcal) to document that these immunizations were offered by the facility and that the resident/responsible party either consented or did not consent to the administration of these immunizations.
CP1800-14
Price: $10.20 
(additional pricing tiers available)
Healthcare workers are among the people most recommended to receive the influenza vaccine. Because of their potential to spread the disease among more vulnerable populations, vaccination of all care facility staff is a sound infection control measure.

Use this form to document the informed consent or refusal to provide consent by an employee to receive the Influenza vaccine.
CP1816
Price: $10.20 
(additional pricing tiers available)
   
Infections are a frequent and common cause of sickness and death in older adults. This user-friendly pocket guide provides important information about common infection issues encountered by direct care workers, and practices that can prevent and control the spread of infections.
  
Co-developed by MED-PASS, Inc. and the Center for Excellence in Assisted Living (CEAL), this easy-to-understand pocket guide provides information about infection control for direct care workers including those in long-term care, assisted living and home care settings.
MP5049GD
Price: $9.95 
(additional pricing tiers available)
Additional Immunization-related Forms
from MED-PASS


 

Item #CP1811

Immunization Record

 

Item #CP1801

 

Item #CP1802
  
Item #CP1815
  
Item #CP1817

 

 

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